| NPI | 1851605851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 5101019008) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 34012255) |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2016-06-28 |